Sažetak
Uvod/Cilj. Bolesnici sa teškom kliničkom slikom COVID-19 imaju viši rizik od razvoja akutnog oštećenja bubrega (AOB). Cilj rada bio je da se analiziraju faktori rizika od AOB/akutizacije bubrežne insuficijencije kod obolelih sa hroničnom bolešću bubrega (HBB), kao i rezultati lečenja primenom kontinuirane terapije zamene funkcije bubrega (KTZFB) kod kritično obolelih od COVID-19. Metode. Istraživanjem je obuhvaćen 101 COVID-19 bolesnik sa AOB, od ukupno 293 bolesnika lečenih primenom KTZFB. Istraživanje je sprovedeno od marta 2020. do jula 2021. godine u Univerzitetskom Kliničkom centru Vojvodine, Srbija. Rezultati. Prosečna starost bolesnika bila je 64,69 ± 9,71 godina. Od ukupnog broja bolesnika, 82,2% bilo je muškog pola, od kojih je 75,2% bilo obolelih od hipertenzije. Na invanzivnoj mehaničkoj ventilaciji (IMV) bila su 93,7% bolesnika, a 92,1% na vazopresornoj terapiji. Prosečna dužina IMV do početka KTZFB bila je 4,65 ± 4,57 dana. U prva 24 sata od početka IMV, 60% bolesnika je zahtevalo KTZFB. Pre KTZFB, prosečna vrednost Simplified Acute Physiology Score II iznosila je 39,13 ± 14,45, kreatinina 312 µmol/L [Interquartile Range (IQR) 208,0–437,5], prokalcitonina 2,70 ng/L (IQR 0,62–7,20), dok je 10,9% bolesnika imalo indeks SpO2/FiO2 > 200 i njih 41,6% anuriju. Prosečan broj procedura iznosio je 2,01 ± 1,36. Najčešći modalitet bio je hemodijafiltracija kod 67,3% bolesnika, a 46% je koristilo oXiris® membranu. Korišćenjem binarne logističke regresije, uključujući demografske parametre, komorbiditete i kliničke parametre pre KTZFB, utvrđeno je da su bolesnici sa prethodnim oboljenjem bubrega imali 3,43 puta veće šanse da razviju AOB, a bolesnici sa indeksom SpO2/FiO2 ≥ 200 su imali 69% manje šanse za AOB/akutizaciju bubrežne insuficijencije u miljeu HBB, zavisne od KTZFB, u prva 24 sata od početka IMV. Zaključak. Utvrđivanje faktora rizika od AOB/akutizacije bubrežne insuficijencije kod obolelih sa HBB značajno je za planiranje njihove prevencije, koja zahteva i primenu KTZFB uz pravilan izbor modaliteta i doze dijalize, vrste membrane/filtera i doze antikoagulansa.
Ključne reči
bubreg, zamena funkcije, kontinuirana;
covid-19;
kritična stanja;
faktori rizika
Reference
Ronco C, Reis T, Husain-Syed F. Management of acute kidney injury in patients with COVID-19. Lancet Respir Med 2020; 8(7): 738–42.
Chan L, Chaudhary K, Saha A, Chauhan K, Vaid A, Baweja M, et al. Acute Kidney Injury in Hospitalized Patients with COVID-19. medRxiv [Preprint] 2020. Update in: J Am Soc Nephrol 2021; 32(1): 151–60.
Mohamed MMB, Lukitsch I, Torres-Ortiz AE, Walker JB, Var-ghese V, Hernandez-Arroyo CF, et al. Acute Kidney Injury As-sociated with Coronavirus Disease 2019 in Urban New Orle-ans. Kidney360 2020; 1(7): 614–22.
Thakkar J, Chand S, Aboodi MS, Gone AR, Alahiri E, Schecter DE, et al. Characteristics, Outcomes and 60-Day Hospital Mortality of ICU Patients with COVID-19 and Acute Kidney Injury. Kidney360 2020; 1(12): 1339–44.
Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int 2020; 98(1): 209–18.
Zhou S, Xu J, Xue C, Yang B, Mao Z, Ong ACM. Coronavirus-associated kidney outcomes in COVID-19, SARS, and MERS: a meta-analysis and systematic review. Ren Fail 2020; 43(1): 1–15.
Robbins-Juarez SY, Qian L, King KL, Stevens JS, Husain SA, Ra-dhakrishnan J, et al. Outcomes for Patients With COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis. Kidney Int Rep 2020; 5(8): 1149–60.
Domecq JP, Lal A, Sheldrick CR, Kumar VK, Boman K, Bolesta S, et al. Outcomes of Patients with Coronavirus Disease 2019 Receiving Organ Support Therapies: The International Viral Infection and Respiratory Illness Universal Study Registry. Crit Care Med 2021; 49(3): 437–48. Erratum in: Crit Care Med 2021; 49(5): e562.
Gupta S, Coca SG, Chan L, Melamed ML, Brenner SK, Hayek SS, et al. AKI Treated with Renal Replacement Therapy in Criti-cally Ill Patients with COVID-19. J Am Soc Nephrol 2021; 32(1): 161–76.
Kooman JP, van der Sande FM. COVID-19 in ESRD and Acute Kidney Injury. Blood Purif 2021; 50(4–5): 610–20.
Nadim MK, Forni LG, Mehta RL, Connor MJ Jr, Liu KD, Oster-mann M, et al. COVID-19-associated acute kidney injury: con-sensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nat Rev Nephrol 2020; 16(12): 747–64. Erratum in: Nat Rev Nephrol 2020; 16(12): 765.
Bilan N, Dastranji A, Ghalehgolab Behbahani A. Comparison of the spo2/fio2 ratio and the pao2/fio2 ratio in patients with acute lung injury or acute respiratory distress syndrome. J Car-diovasc Thorac Res 2015; 7(1): 28–31.
Tan BWL, Tan BWQ, Tan ALM, Schriver ER, Gutiérrez-Sacristán A, Das P, et al. Long-term kidney function recovery and mortality after COVID-19-associated acute kidney injury: an international multi-centre observational cohort study. EClinicalMedicine 2022; 55: 101724.
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2(1): 1–138.
Bezerra R, Teles F, Mendonca PB, Damte T, Likaka A, Ferrer-Miranda E, et al. Outcomes of critically ill patients with acute kidney injury in COVID-19 infection: an observational study. Ren Fail 2021; 43(1): 911–8.
Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Cas-telli A, et al. Baseline characteristics and outcomes of 1591 pa-tients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA 2020; 323(16): 1574–81. Erra-tum in: JAMA 2021; 325(20): 2120.
Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the Seattle re-gion - case series. N Engl J Med 2020; 382(21): 2012–22.
Argenziano MG, Bruce SL, Slater CL, Tiao JR, Baldwin MR, Barr RG, et al. Characterization and clinical course of 1000 pa-tients with coronavirus disease 2019 in New York: retrospec-tive case series. BMJ 2020; 369: m1996.
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020; 323(20): 2052–9. Erratum in: JAMA 2020; 323(20): 2098.
Chan L, Chaudhary K, Saha A, Chauhan K, Vaid A, Zhao S, et al. AKI in Hospitalized Patients with COVID-19. J Am Soc Nephrol 2021; 32(1): 151–60.
Doher MP, Torres de Carvalho FR, Scherer PF, Matsui TN, Am-mirati AL, Caldin da Silva B, et al. Acute Kidney Injury and Renal Replacement Therapy in Critically Ill COVID-19 Pa-tients: Risk Factors and Outcomes: A Single-Center Experi-ence in Brazil. Blood Purif 2021; 50(4–5): 520–30.
Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clini-cal and biochemical indexes from 2019-nCoV infected pa-tients linked to viral loads and lung injury. Sci China Life Sci 2020; 63(3): 364–74.
Husain-Syed F, Slutsky AS, Ronco C. Lung−kidney cross-talk in the critically ill patient. Am J Respir Crit Care Med 2016; 194(4): 402–14.
Van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the criti-cally ill: a systematic review and meta-analysis. Crit Care 2013; 17(3): R98.
Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bru-yère R, et al. Timing of Renal-Replacement Therapy in Pa-tients with Acute Kidney Injury and Sepsis. N Engl J Med 2018; 379(15): 1431–42.
Gaudry S, Hajage D, Benichou N, Chaïbi K, Barbar S, Zarbock A, et al. Delayed versus early initiation of renal replacement ther-apy for severe acute kidney injury: a systematic review and in-dividual patient data meta-analysis of randomised clinical tri-als. Lancet 2020; 395(10235): 1506–15.
Ostermann M, Joannidis M, Pani A, Floris M, De Rosa S, Kellum JA, et al. Patient Selection and Timing of Continuous Renal Replacement Therapy. Blood Purif 2016; 42(3): 224–37.
Knežević V, Azaševac T, Stražmešter Majstorović G, Marković M, Ružić M, Turkulov V, et al. The importance of anticoagulation in COVID-19-related acute kidney injury requiring continu-ous renal replacement therapy. Srp Arh Celok Lek 2022; 150(1–2): 29–34.